氟尿嘧啶乳膏对治疗角质形成细胞癌（非黑色素瘤皮肤癌）和光化性角化病的成本的影响。

Impact of topical fluorouracil cream on costs of treating keratinocyte carcinoma (nonmelanoma skin cancer) and actinic keratosis.

机构信息

Health Economics Resource Center, Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Center for Innovation to Implementation, Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Department of General Internal Medicine, UCSF School of Medicine, San Francisco.

Health Economics Resource Center, Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Center for Innovation to Implementation, Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.

出版信息

J Am Acad Dermatol. 2018 Sep;79(3):501-507.e2. doi: 10.1016/j.jaad.2018.02.058. Epub 2018 Mar 2.

DOI:10.1016/j.jaad.2018.02.058

PMID:29505863

Abstract

BACKGROUND

It is unknown whether treatment costs for keratinocyte carcinoma (KC) and actinic keratosis (AK) can be lowered by spending more on chemoprevention.

OBJECTIVE

To examine the impact of 1-course treatment with topical fluorouracil (5-FU) on the face and ears on KC and AK treatment costs over 3 years.

METHODS

The Veterans Affairs Keratinocyte Carcinoma Chemoprevention trial compared the efficacy of topical 5-FU 5% with that of vehicle control cream for reducing KC risk. Trial data and administrative data on costs and utilization were analyzed to measure postrandomization encounters and treatment costs for KC and AK care. Adjusted models were used to test for statistically significant differences between treatment arms for number of treatment encounters and costs.

RESULTS

One year after randomization, the control arm had a higher mean number of treatment encounters for squamous cell carcinoma (0.04) than the intervention arm (0.01) (P < .01). At 1 year, the intervention arm had lower treatment and dermatologic costs: $2106 (standard deviation, $2079) compared with $2444 (standard deviation, $2716) for the control patients (P = .02). After 3 years, the intervention arm incurred a cost of $771 less per patient.

LIMITATIONS

Care not provided or paid for by the Department of Veterans Affairs was not included. Results may not be generalizable to other payers.

CONCLUSION

We found significant cost savings for patients treated with 5-FU.

摘要

背景

目前尚不清楚在角化细胞癌（KC）和光化性角化病（AK）的治疗中，通过增加化学预防的投入能否降低治疗费用。

目的

研究面部和耳部单次外用氟尿嘧啶（5-FU）治疗对 3 年内 KC 和 AK 治疗费用的影响。

方法

退伍军人事务局角化细胞癌化学预防试验比较了外用 5%氟尿嘧啶与赋形剂乳膏对降低 KC 风险的疗效。分析了试验数据和成本及利用的管理数据，以衡量随机分组后 KC 和 AK 护理的就诊次数和治疗费用。采用调整模型检验治疗组间治疗次数和费用的差异是否有统计学意义。

结果

随机分组 1 年后，对照组鳞状细胞癌的治疗就诊次数（0.04）明显高于干预组（0.01）（P<.01）。1 年时，干预组的治疗和皮肤科费用较低：干预组为 2106 美元（标准差为 2079 美元），对照组为 2444 美元（标准差为 2716 美元）（P=.02）。3 年后，干预组每位患者的成本节省了 771 美元。